Healthcare Provider Details

I. General information

NPI: 1407764046
Provider Name (Legal Business Name): MARY HANNAH BRANNON DUFFY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 S 17TH ST
WILMINGTON NC
28401-7407
US

IV. Provider business mailing address

8233 SAGE VALLEY DRIVE
WILMINGTON NC
28411
US

V. Phone/Fax

Practice location:
  • Phone: 910-667-7000
  • Fax:
Mailing address:
  • Phone: 910-667-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number159974
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: